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Home Care Marketing & Sales Mastery by Approved Senior Network®
Dawn Fiala, Lisa Marsolais, Annette Ziegler, and Valerie VanBooven RN BSN provide insight into home care marketing strategies. They cover in-person, in-field sales and online marketing every other week. These podcast episodes are part of the Home Care Marketing Mastermind, sponsored by Approved Senior Network®. Find more information at https://ASNHomeCareMarketing.com
Home Care Marketing & Sales Mastery by Approved Senior Network®
Home Care Marketing - Add Revenue with Long Term Care Insurance Claims Expertise
The wave of long-term care insurance claims is rapidly approaching, and home care agencies need to be prepared. With nearly 4 million policies written between 1995-2005, we're entering a period where these policyholders—now in their peak claim years of 80-85—are seeking home care services in record numbers.
Bill Comfort, with over three decades of experience in long-term care insurance, walks us through the critical steps agencies must take to successfully work with these valuable clients. First and foremost is understanding whether your agency qualifies as an eligible provider under various policy definitions. While many policies use the term "home health care" generically, the actual definitions vary widely. Most policies specify providers must be "licensed by the state if licensure is required"—a crucial distinction for agencies in non-licensure states.
Documentation emerges as perhaps the most critical factor in successful claims management. Agencies must carefully document whether assistance with Activities of Daily Living (ADLs) is hands-on or standby—a distinction that can determine claim approval or denial. The caregiving notes must consistently reflect assistance with at least two of the six ADLs (bathing, dressing, transferring, toileting, eating, and continence) for clients to maintain benefit eligibility.
Payment structures present another consideration, with Bill strongly recommending against accepting assignment of benefits until claims are fully established. This protects agencies from financial exposure when claims are delayed or denied. Instead, establish procedures to help clients submit claims while maintaining your direct billing relationship.
Building referral partnerships with financial advisors and insurance agents offers tremendous growth potential. Organizations like NAIFA and FPA provide perfect networking opportunities where agencies can position themselves as knowledgeable resources. By demonstrating expertise in navigating long-term care insurance claims, your agency can attract both insurance-funded and private-pay clients.
Ready to position your agency as an expert in long-term care insurance claims? Learn more about obtaining the Long-Term Care Claims Professional certification to demonstrate your expertise and grow this valuable revenue stream.
Continuum Mastery Circle Intro
Visit our website at https://asnhomecaremarketing.com
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This is going to be a fun, a good one, an informative one. These are the things I've always wanted to know, being in home care almost my entire career long-term care. We know we want those clients, we want them, we need them, but we aren't always sure how to navigate and how to get them. So we have Bill here today who's going to help us with that. First, we're going to go through our housekeeping items. Lisa, you want to be the one? Yeah, for sure. Okay, I'm not sure if Scott is going to be able to join us today or not, so we'll go ahead and get started.
Speaker 2:And you guys already saw the chat, so if you have anything to tell us, you can just get in there and let us know. So lines muted unless you're speaking. Share stories, experiences, tips, ask questions, make recommendations and tell us what you want to know for future. Next slide oh hey, it's us Reintroductions. I guess I can start, since I'm already speaking, but I'm Lisa Marcella. I have been with ASN for two years now. It's been a lot of fun. It's really taken all of my experience in home care as well as back in the day with newspaper and just shoved it all into one. So it's a very perfect place for me to be. Definitely, I love being a part of your guys' journey. I can't stay in one lane in home care, so this is just. This is perfect and I love being a part of it. Thank you for letting me be a part. Got off track there, but I'll go ahead and give it over to whoever's next. Should it be Annette, you want to go?
Speaker 3:Hi everybody. I'm Annette Ziegler. I know a lot of you here. I have been in home care for over 20 years. I teach the sales training classes here with ASN. I'm almost here a year. I love what I do. I love teaching you how to get those private pay referrals grow your agency. Really glad you're here. Very excited to have Bill here. I told him I wish I knew him when I was in home care, so it's going to be a great topic today. Thanks for being here.
Speaker 1:Amen to that. I feel the same way. I'm Dawn Fiella. I have been with ASN for close to three years now. I also have a background in home care I like to say, in the trenches of home care for close to 20 years. I've learned a lot along the way. We've shared a lot of that with you. We share a lot of that with you here in Mastery. Thank you for joining us today and allowing us to be a part of your journey, and thank you for all you do with your seniors out there and the care and support you're providing them. I don't know if Valerie is going to join us today. You're providing them. I don't know if Valerie is going to join us today. She is a co-owner and founder of Approved Senior Network. She's a nurse by trait and she's been doing this since 2008. We do a lot of websites and online marketing and SEO, in addition to the feet on the ground training. So we'll keep going, lisa you're up again.
Speaker 2:Okay, how to watch the meetings you missed. What you're going to do is next slide. I'm not driving, so All right. So you want to go log into the forum and did I miss a slide there? So home care marketing and sales support forum is right here. There you go. Home care, home care sales forumcom. There we go. And your username is your email address. So whatever you signed up with us at the beginning with is your. That's your email address, and then you should have got a password sent off to that email. If you don't remember it or just can't find it, you just can click on the forgot your password option there, and this little square is what it'll look like when you get in there. And then what you want to do is go straight to where that arrow is pointing. It says learning. If you go to the discussion, of course you can go in there too and you can talk to all of us your colleagues, peers, all of that, ask questions, get ideas. But you want to go to that learning to get into the master masteries, sorry. And then, okay, there we go. Cool, we changed the slide. I forgot that we did, but there you see we have 2024 over there. But you want to go into that 2025, click on there, open that up and it will give you a list of different. For example, here's January 2025 and the two that we did that month, and then as you scroll down you can see February and on as we get them out.
Speaker 2:All right, the mobile version. So hopefully everyone's downloaded this already, but it's Colab app and it's with a K-L-A-B how to use it and what it's for. So you'll get here. It's called Lead Connector by old Colab, by Lead Connector, and here is one for Apple. So you can if you have Apple or your Samsung, but it looks pretty cool on your phone, you can see here. So there's a couple of different links. Yes, yes, and boom, okay, so you can go on. So you see there's a whole bunch of different things going on here. But right here, the first there is a where you can just click on video so you can actually watch the replay. You can also go to the next slide over and you can actually click on different links within the replay so you can go into the leave behinds or anything else there. I can't see the bottom of the screen on my oh, okay.
Speaker 1:Down in the bottom, all of you see the circle blue.
Speaker 2:Yeah, now I can see it. Yeah, it's kind of at the bottom there. It's almost like all the different pages, and so you have the homepage of discussion and circled right there is learning and that's all you have to click on and then you can get here. So here you can see different, all the different features that we have, so you can ask questions, you can see other people's leave behinds or any ideas that they had, you know, used and shared with us. You can share anything on here and you can ask any questions at all and we usually get back to you very quickly. We also did something really cool because we listened and we put it to use, but we created a homecaremarketingnewscom store. So this store, we did the legwork for you, no-transcript, and now we're up.
Speaker 1:So we have Bill Comfort, csa, cltc, ltccp. He's got lots of credentialing there behind his name. He is an independent long-term care specialist at Comfort Long-Term Care. He is in Raleigh, durham, chapel Hill, North Carolina and beyond. 34 years in the insurance business, former radio and TV journalist that's very cool. His mission is to help individuals and families protect against and financial costs of long-term care disability. He consults nationally with private duty home care industry, educating care providers on long-term care disability. He consults nationally with private duty home care industry educating care providers on long-term care insurance claims, and he's certified in all 50 states. So that's awesome.
Speaker 1:We've got an agenda here. Before we get started, though, we do one giveaway every meeting of customized leave-behinds. This time you will get April leave-behinds. If you would like for us to take all the April leave-behinds. This time you will get April leave-behinds. If you would like for us to take all the April leave-behinds we're going to share with you later, and put your phone number, your logo, your colors on it. We need you to type the word yes in chat. There is one little thing, though you have to promise to take pictures and send them to us so we can share them with everybody here at Mastery. So please type the word yes if you want to be the winner. There will be one winner for the April Leave Behinds. Type the word yes in chat and remember you have to take pictures. We will be tracking you down and that's going to start tracking down those February people. She's already got a list.
Speaker 1:Okay, the agenda for long-term care insurance. This is a step you guys have always wanted to know how do you build strong relationships with long-term care referral partners to receive more long-term care insurance clients. Learn the process for onboarding long-term care insurance clients to home care services, enabling faster claims and stronger partnerships with referral partners, and then understand the different payment structures between long-term care carriers and home care agencies, including direct payments to the agency versus client-paid models. So Bill's going to go through and cover all of this. Please type your questions you have for Bill in the chat and we will make sure that they get answered. Welcome, bill. We are thrilled. I feel like I've waited 20 years to hear this.
Speaker 4:We are thrilled to be here today. Yeah, thank you. I feel like I've waited probably 15 years to be a part of this. I actually, Valerie and I worked together back in probably 2001. There she is we're getting the band back together, Valerie.
Speaker 5:You know what I cannot believe. It's been 25 years. That is weird and crazy that we could possibly be that old. We were young sprites when we first met and we're all into long-term care and stuff.
Speaker 4:And we're still in long-term care. So I think that says something either about our patient's virtue, or maybe just stupidity, I'm not sure what.
Speaker 1:All right, bill, I'm going to be your driver, so just tell me when you want the next slide to come up. And you're up there, you go.
Speaker 4:This is great and let me start by saying I wear two hats in my professional life. My main hat, my day job, depending on which day it is selling long-term care insurance, engaging with clients, their other advisors about planning in advance for care and buying long-term care insurance to help fund that in whatever form, in whatever way, and that's. I've sold long-term care insurance for more than 30 years. Valerie was part of helping to start a specialty agency in St Louis back in 2000. So it's really all I've done in the insurance business for the last 25 years. My other hat is as a continuing education instructor and I've taught for the CLTC Certified in Long-T care program for 23 years now, which is really for agents and advisors planning for care how to engage clients in that advanced planning conversation. Obviously, long-term care insurance is part of that. But starting about 16, 17 years ago I began doing private consulting with the home care industry. In doing training around long-term care insurance but looking at it from the claims perspective, particularly from the view of a home care provider, years ago I started a designation that I really just used for my private consulting clients called LTCCP Long-Term Care Claims Professional. It's an in-depth training in understanding long-term care insurance from your viewpoint, what happens at time of claim? What do you all need to do, what do you need to be aware of? And we're going to touch on a lot of those issues, at least in an introductory way, today. We're also going to share with you how you can take the course. We opened it back up, updated it on the third edition of the textbook last December, so it's now available publicly and we've got a discount for those of you in the ASN network. That's my business and the reason this claims discussion is so important.
Speaker 4:Whatever level of clients each of you have in your offices, your agencies that have long-term care insurance, over the next 10 years, long-term care insurance over the next 10 years, the number of people who are going to need care with long-term care insurance is going to significantly increase. I don't know if it'll double, but it's going to be a measurable increase looking forward, particularly over the next 10 years. And the reason is because there's about 7 million give or take people who have long-term care insurance and half, a little more than half, of those three and a half pushing 4 million policies pushing 4 million policies were written just in the 10 years between 1995 and 2005. Those were the largest sales years for long-term care insurance. We peaked in 2002. 750,000 individuals bought a policy just in 2002. And let me give you a comparison Last year it was about $150,000. And that includes regular long-term care insurance and just life insurance with a specific long-term care rider.
Speaker 4:But here's the impact for you all today. Think about a 60-year-old who bought her long-term care insurance in 2002. How old is she today? She's 83. What's the peak claim years 80 to 85 is the very top of the steep bell curve when long-term care insurance claims begin. 75 to 85, you guys know the ages of the folks that are coming to you. So we are going to see these policies that were written 20 to 30 years ago. Those are the policies that are coming to claim today and it's a bigger wave, a bigger cohort of older enforced policies than we've ever seen in long-term care insurance. The carriers are scrambling to be ready for this. They're also pushing back in some ways, because this is where the money starts going out the door for them as well.
Speaker 4:So being savvy for your business and in partnership with your home care clients, I think is really important and that's what we're really going to focus today on. So go ahead Dawn. So just to start, there's three levels, so we're going to look at each of these very generally. But the first thing is to understand is your office, your agency, even going to be a covered provider? Questions around this. We were talking before we opened the webinar today about things like licensure and so on.
Speaker 4:What I want to focus on is this middle point. What does your client, your home care client, who owns a long-term care policy, what does her policy actually say? Policy actually say? Not on the schedule page, because most of them say home health care, and I know you're not home health care, but long-term care insurance uses that term very generically. So the best advice that I can give you and part of what this LTCCP training does is really disassembles long-term care insurance contracts to show you what to look for, where to look for it, how to read the contracts in detail, Because you want to look and see what is home health care generally and how is a home health care agency defined.
Speaker 4:And there's a whole range of definitions, particularly policies that were issued in the mid to late 1990s After about 2000,. We have a lot more standardization, but again we're just beginning to get claims from the most modern era where there's more consistency across policies. So this cohort this claims wave that's coming has policies with home care definitions that are all over the place. A covered agency says you must be licensed by the state and you're in a non-licensure state like Arizona or Missouri, you might not be a covered provider. It's possible, but a lot of policies have what's called an alternative plan of care provision where the client can negotiate your client, the policyholder can negotiate for an alternative payer. And the problem is Valerie this is going back probably 15 years, but CNA was notorious back in the 1990s for policies that said have to be home health care licensed to bill Medicare? Basically there were like two home health agencies that had the proper licensure, that were even willing to staff, willing and able to staff custodial care, private duty shifts for three or four or eight hours a day.
Speaker 4:Carriers have gotten better. Cna has moved away from being so strict on this and so that kind of is an alternate negotiation, but it's a negotiation and the carrier could say no, probably the most common language. And this is where you need to be very savvy. Don't just take your client's word, the policyholder's word of what they heard the insurance company say to them. Get with your client and sit that either get a copy or sit down with them at their kitchen table and look at their actual policy, like the 40 or 50 page policy, and find the page that defines a home healthcare agency, and the language that I think you're going to see that's the most common is it says you have to be licensed by the state if licensure is required. Now I've seen carriers that have just loaned past that. Look, what are they trying to do? They're trying to at least postpone starting to pay for a claim. Maybe they'll end up paying for it six months a year down the road or when the person goes to assisted living or skilled nursing, but that saves the insurance company money. Look, I could be a happy cynic about my own industry here. If the definition says industry.
Speaker 4:Here, if the definition says must be licensed if required by the state, you need to have, if you're in a non-licensure state, a system of reporting with some documentation to the insurance company, to your client, to give to the insurance company or you provide directly to the insurance company as part of the process that validates this. And an idea that I got way back in the early 2000s back in St Louis was a local agency in Missouri wasn't licensed because it wasn't required. And what this owner did was wrote to the state it's probably Department of Health and Human Services that licenses the skilled home health agencies, the Medicare agencies right Wrote to them and said do I? Basically said do I need to have a license to do private duty custodial home care in Missouri? I'd like a letter explaining this. And he got a letter back that said in Missouri licensure is not required. And he kept a copy of this letter and it didn't matter what the definition said, every home care claim, every client he had with long-term care insurance excuse me, he would send a copy of that letter in so you might explore that option. Your state dawned like in Arizona as we were talking before we started.
Speaker 4:Some policies say you have to be licensed if it's required by the state. If not, there's then a list of criteria and almost every time I've seen the list, your agency is going to meet that criteria, especially if you have a nurse on staff to be able to supervise, to write plans of care, do training, those kinds of things which most offices do. If you don't have an RN on staff or on contract that you can show, that's a little tough, but in my experience most agencies are going to have that, where the one kind of organization of how you're structured where there could be an issue is if you're truly a registry where your providers, your caregivers, are 1099 employees. That could be an issue because you are not an organized professional agency. The only exception would be Florida, and Florida has very unique, specific laws relating to long term care insurance. It's not in the contracts but basically behind the scenes. The insurance law says in Florida a registry must be considered the same as a formal, organized home care agency. That's of course irritating if you are a formal agency with employed caregivers because the registries maybe end up being more competitive.
Speaker 4:But we're looking from a different angle. So obviously you have to live with your state requirements for your business. North Carolina has a licensure for private duty custodial home care, so that covers a multitude of different definitions, because some policies just say you must be licensed by your state definitions. Because some policies just say you must be licensed by your state. Where we see the problems again is you have to be licensed as home health care, skilled care, some say to bill Medicare, or certified by the Joint Commission, which is effectively the same thing. That's what you want to look out for. I think more and more as we're working from kind of 95 policies issued in the mid-1990s forward, most of you are going to be able to navigate around these definitions.
Speaker 4:But you have to know what the definition is and sometimes you've got to go to bat for your client, the policyholder, and either help them say, or get on the conference call and say to the claims person we meet every piece of the definition on page 14 of Mrs Jones' policy. That's not, that's generally not. I had this come up recently. We have a standard for how we evaluate it and I said to the person I said I don't care what your standard procedure is. This specific policy says this and it should be covered. We'll have to look at that. I said get a supervisor on the phone right now, right, covered, we'll have to look at that. I said get a supervisor on the phone right now, right. You know the drill, but that's sometimes what you have to do. Let me pause here, dawn, and see if anybody has any questions or kind of examples around us that we ought to discuss before we move on.
Speaker 1:I do have a question. So there is Victoria takes long-term care insurance. However, they do not bill the LTC because oftentimes they don't pay. Do you have any tips? We have to provide documentation and 3D, adls et cetera. I know we would get more clients if we build the company directly.
Speaker 4:Yeah, let's go to the next slide, because that's something we had talked about. Let me address. Leave this slide up. Let me address the question directly. So what you're describing in the direct billing or direct payment from an insurance company, that's called assignment of benefits and maybe a lot of you probably heard that term. So assignment of benefits simply means the policyholder, your client, signs a form or writes a letter that says, instead of me, the policyholder receiving the check each month, I just want you to send it to my provider directly. Same things have to happen. You have to still show caregiving notes and invoices and the insurance company has to review and adjudicate all of that month in and month out. So assignment of benefits can be tricky.
Speaker 4:However, I never recommend that you take assignment of benefits at the very start of a claim. Are you even an eligible provider? Has that been determined yet? Is the policyholder even benefit eligible? I've worked with home care agencies where they've gotten two, three months into services and basically the person's not even eligible to go on claim yet. And the client crosses their arms and says well, you agreed to take the insurance, it's not my problem, they're not paying Now, you got to sue. The client crosses their arms and says well, you agreed to take the insurance, it's not my problem, they're not paying. Now you got to sue the client. It's just a mess. So this idea of accepting assignment should only be done after the claim started, that you and the client know they are benefit eligible, approved We'll talk about that in a moment that you're an approved provider and that elimination period, that 60 or 90 days that's already run.
Speaker 4:Basically, don't take an assignment of benefits until your home care client has already received at least one, if not two, checks from the insurance company for your services. That's my bright line advice on that. It can, let's say, the carrier, six months in, does a review and they dig through the notes and it doesn't appear that the caregiver is providing any ADL support, for example, and they pause the claim. They say it doesn't look like Mrs Jones is eligible anymore. So it's probably a mistake. But there could be a month or two of delay. Often they will go back and pay in arrears, but you all know you can't float a month or two months worth of invoices that way without consistent payment coming into your business.
Speaker 4:Look, it's a business practice decision. I'm hearing more and more home care offices, agencies, say we're not doing assignment of benefits anymore. We work our butts off to document everything properly for long-term care insurance, to send direct to the insurance company the caregiving notes, the plan of care and the weekly or monthly invoices so they can see everything. But our deal is with our client. They pay us and we help the claims go through, but the client gets reimbursed. By the way, that's how long-term care insurance is designed to work Back in the 90s and the policies we sell today. They are not designed to pay you.
Speaker 1:And you could even use that with clients.
Speaker 4:Yeah, go ahead.
Speaker 1:I have a question about that. So how long might the client wait to be reimbursed by the insurance company? Because that's the next thing they're going to ask Okay, I'm paying you, when am I going to get paid If you're doing all the things? We're just sending the ADLs, we're sending the plan, we're done all the check is all done. How long will they be waiting to get payment?
Speaker 4:It's really a question when you're at the very start of a claim. They've never been on claim before they're starting the claim. Most claims 80% of all long-term care insurance claims start at home. That's not surprising to any of us. So if they have a 90-day elimination period, some people call it a waiting period, but that could be a misnomer or lead to some misunderstanding. The 90-day deductible period which they chose at the time they bought the policy could be a little shorter, could be a little longer, but 90 days 100 days is the most common that you're going to see. There's no benefit paid for 90 days, whatever that period is. But let's use 90 in the example and let's say during that 90 days the company is efficiently processing and agreeing that your client is benefit eligible, that you're an eligible provider, that they're counting the days and at the end of 90 days the client has been paying out of pocket because it's their deductible period.
Speaker 4:The elimination period is the deductible in long-term care insurance. So most people think they're going to get a check on day 91. I'm sure Most policies are what are called reimbursement, so they reimburse for expenses that have already been approved and paid. First check you have to get to the end of the fourth month, with services billed and paid by the client during the fourth month. At the end of the fourth month those invoices go to the insurance company. They review them. That takes a week or 10 days. They put it into their payment system, which maybe takes another week or 10 days. So what I tell people? Best case scenario at the start of a claim where you have to get through that elimination period, they are not going to see their first check for at least five months.
Speaker 1:Okay, wow, we've got more questions. Yep, Go ahead. If requested by long-term care for an assessment copy of a care plan or any other documentation, how can we charge for the time it takes us to do that start of a claim and how much do you suggest for one hour assessment?
Speaker 4:That's an interesting question and I'm going to give you an opinion. That's just my opinion. I think there's an ethical question here that you have to sort out in your business and how your business is organized. Are onboarding a home care client with long-term care insurance? You have a responsibility, bill's opinion, to do whatever it takes from your role as the home care provider to get to the client and or the insurance company the information that's needed for them to use this payment source. Most agencies don't bill for that time. Might it take some extra time and effort? Yes, but recognize this is also a client. If you do it, they have extra resources, they have extra funds.
Speaker 4:A large agency I just was talking to the owner large agency in my area here and he has a significant number of long-term care insurance clients. He said on average, the monthly billing for his clients with insurance versus just private pay out of pocket versus just private pay out of pocket, it's 50% higher on average. So I think it's worth it for you to do that. Now let me here's my caveat, and I think where the ethical question is if you have a home care agency and you provide already like a separate care management service that you bill for on an hourly basis. If that's part of your business structure, then maybe you tell the person look, this takes extra time and this is going to be a care management service that could take an extra hour or two and you bill your hourly rate. But if you don't operate that way, I would not charge an extra fee. I think it's part of the cost of doing business and working with long-term care insurance. Bill's opinion.
Speaker 1:Okay.
Speaker 4:Interesting question.
Speaker 1:Yeah, We've got lots of questions. I'm having issues with an insurance company not noting if elimination period is service days or calendar days.
Speaker 4:It's in the contract. It's one of those things you have to find, smoke out and identify in the contract. So let me give you an example Genworth, which is the largest in-force company. They've got a million two policies in force and again, probably half or more of those were written between 95 and 2005. And those are coming to claim today. They have policies with a zero day home care elimination period, meaning benefits start day one. They have policies that have a service day elimination period and they have policies where people chose what's called a calendar day as a better option, a more liberal option, as a way to count those days.
Speaker 4:Those days you have to look in the contract and in my world and my advice to you don't ever trust what the insurance company is telling you. You've got to verify it. In fact, I would not advice to you, I would not onboard a long-term care insurance client if they will not let you see their actual policy. And I know sometimes that's a trust issue. They're afraid if you see it's like I'm going to show you my bank statement or something, you're afraid you're going to overcharge them and use up their policy too fast. Look, you just got to overcome that kind of trust and new client engagement. Maybe they'll give you a copy of it, maybe you again sit down with them at the kitchen table and you could even use some of these issues as a way to explain why you need to do it together.
Speaker 4:The way the elimination, the way the 90 days are counted, mr and Mrs Jones, we have to know that for home care, because in some policies you have to hire us seven days a week that's service days to get 90 days in three months. Your policy might just require us only to be here one day a week and we need to work together on this. And I got to tell you the person on the other end of the 800 number, john, excuse me, genworth administers today in their claims department, which is in-house, they administer close to a thousand different contract forms issued by Genworth, ge, amex. They also manage the Travelers Block of Business and dozens of other little companies that have outsourced claims to Genworth as their TPA. So that claims person, they're not reading a specific contract, they're working off a guideline screen.
Speaker 1:Right, okay, we've got some more. After the waiting period, elimination period and claim is approved, does the policyholder stop paying their LTC premiums?
Speaker 4:In most cases. Yes, the term is called waiver of premium and most policies waive the premium after the elimination period once benefits become payable. Some policies you got to go another 30 days or 90 days after the EP, but most commonly after that elimination period's run. But most commonly after that elimination period's run, premiums are forgiven. If a policy was issued in the 1990s, anywhere in the 1990s you want to look closely at this Wasn't common. But some policies only waive the premium if you're in a facility, but they don't waive it for home care. So it's not universal. But most policies I think that you run into will and, by the way, that's a great thing to be able to show a client in their policy if you're reviewing it with them to help, particularly if they're saying things like we don't really want to start using our policy now, we want to save the benefits for later.
Speaker 4:You hear that I'm hearing a lot of offices ask that question to me and one of the reasons to start a policy today is you get to stop paying premiums and, by the way, you don't have to use the whole benefit. You could choose. If they have 6,000 a month and you're only billing them 3,000, they're only drawn down 3,000 a month, for example. Or let's say their policy is $6,000 a month and you're billing $6,000 a month or more, they could choose to only submit half the claims for reimbursement and it just it. Generally, from a financial planning standpoint I get it. I get the emotion behind it, but from a financial planning standpoint it makes no sense to not use your policy and your policy's benefits as soon as possible. But the waiver of premium often gets people's attention. So that was a great question, good.
Speaker 1:Great, that's all the questions we have. We have a few more minutes, so go ahead. Please tell us more.
Speaker 4:Yeah. So let me touch on what we have on the screen here We've talked about. Are you a preferred provider? Benefit eligibility is really the number one issue at time of claim. Nothing happens, the elimination period doesn't run, days of your service aren't credited if they're not benefit eligible, and that's the two physical activities of daily living or, separately, supervision for a cognitive impairment. Most policies and we don't really have time to get into sort of the 1990s versus what's called tax qualified policies, which have some subtle differences, but most policies have two out of six activities of daily living Bathing, dressing, transferring, toileting, eating and continence are the six.
Speaker 1:But we have to be doing two of those for them to qualify.
Speaker 4:But we have to be doing two of those. For them to qualify, they have to need assistance with two of those correct.
Speaker 1:Okay, got it.
Speaker 4:Now this is critical. It's probably the biggest mistake that I see being made in home care agencies today when it comes to claims eligibility and that is not understanding and not properly recording in the plan of care and not consistently charting by the caregiver whether the help is hands-on help or standby help. Totally, most long-term care insurance will approve a claim or a loss of an ADL. If it's simply standby assistance, how do you know? You have to read the contract. Especially in the 1990s there were policies that were hands-on only. But I think in the claims you're going to see today and looking forward, the majority are going to measure an ADL loss on a standby basis. You have to chart it. I have three claims appeals I'm in the middle of right now where somebody been on claim for nine months a year and a half in one case and the insurance company did a review and said they're no longer benefit eligible. They only need help with one ADL. I reviewed four months the most recent four months of care notes, daily care notes. There was not one mention in those care notes or check boxes from the caregiver in the house that they ever did any more than one of the insurance ADLs. Now they tried to tell me that well, they do transferring all the time they drive her to appointments.
Speaker 4:Transferring is not an ADL for long-term care insurance. You got to bathing, dressing transferring. Those are probably the three most common. Toileting is actually right up there because of somebody's mobility impaired. This is interesting. Most people don't know this. It's new on my radar screen as well. The last few years of toileting says the ability to safely get to and from and on and off the toilet and obviously hygiene. But if somebody needs help getting in and out of a chair or a bed, which is transferring, they probably also need help getting on and off the toilet. There's two ADLs right there and it says to and from. If they're mobility impaired, they might be toileting impaired and remember it's probably standby assist and it has to be both in the written plan of care and it's got to be reflected consistently in the caregiver's notes, however those are charted or reported.
Speaker 1:You're so right, bill. We had a couple of claims that we had to fight. Also, you guys have to really watch what the caregivers are charting. If you have an LTC client, that you need to have them stand out somehow. If there's a new caregiver for three days or something, they have to be alerted to do this. You've got to check over and over because it is not worth having to figure out later.
Speaker 4:It is a nightmare. Let's change the slide here. I want to make sure we cover some of the things or that. So yeah, just to that last point. There is a training issue here with the caregivers. I had a person share in the LTCP class last week that the business manager of the agency, if they have a long-term care insurance client, every care note is reviewed in detail before it's sent to the insurance company. And if they know there's two or three ADLs on at least a standby basis and they're seeing that one of them's not being charted, they will go back and work with the caregiver to amend those notes before they go to the insurance company.
Speaker 2:Absolutely.
Speaker 4:Very valuable. I want to talk a little bit it's really this screen and the next screen about some ways you can use your knowledge your expertise, if you feel like you have it with long-term care insurance for marketing and go on to the next screen now, and these are some different groups obviously you can network with, but I want to focus specifically on financial advisors and insurance agents as potential referrers to you. You want to reach out to these groups. Want to reach out to these groups not just asking for them to refer their long-term care insurance clients, who need care, to you, but insurance agents and financial planners. They're going to have clients in their 70s and 80s that don't have long-term care insurance but who need care. How about if you're that financial planner's go-to resource about all things knowledgeable about home care? See, you're going to get referrals for private pay out-of-pocket clients from them, but they are also going to know when they have clients with long-term care insurance. So you're covering both bases. And let me give you two ideas.
Speaker 4:Insurance agents have a national association that many of them belong to called NAIFA N-A-I-F-A, and it stands for Insurance and Financial Advisors. Whatever NAIFA N-A-I-F-A you can Google it. Google NAIFA Scottsdale I'll bet there's a local chapter in the Phoenix, scottsdale or wherever you are, and they have monthly or quarterly meetings. They often will welcome a guest. Just go and network and have coffee. They're always looking for speakers. If you did a 25-minute presentation on the difference between home health care and home care and what pays for what and what doesn't, you'll blow their minds and you'll get their attention and you'll build those relationships as relationships.
Speaker 1:That's a great idea, and we have a lead behind guys.
Speaker 4:That's the differences between non-medical and medical home care. I'm telling you a 20 or 25 minute presentation at one of these meetings. It would really resonate. So the other organization I want to share with you is FPA. Stands for financial planning association. That's what CFPs, Certified Financial Planners, belong to. Pa is more financial advisor, financial planner oriented, but I mention it because they also have local chapters with regular meetings all over the country. They welcome visitors like you all as well.
Speaker 1:And Annette's put those in the chat. Guys, the links are there for you in the chat so you can copy and copy them.
Speaker 4:So I think go one more slide here. This is the shameless plug slide from your presenter today. What we've done is in our 40 minutes or 45 minutes here is just scratch the surface. You've gotten the key ideas of things to look for. This is the course I developed 10 years ago and that we've recently relaunched Long-Term Care Claims Professional. If you sit through a live Zoom class it's five hours. You're probably going to spend another couple hours with the textbook and the online review quizzes before you take the exam. We're going to have online recorded videos that you can self-study from. They should be open and available in the next week or two for this.
Speaker 4:It's a 140-page textbook that's full of tips, not just definitions, not just how the policy works, but what do you have to do as a home care provider, especially regarding these different definitions, problematic definitions or the plan of care, and examples where there can be issues and so on. So that's all part of this course. You can see the website there ltccpcom. There's a lot more information there and I'm extending a discount to everyone in the ASN network for 150 off the regular tuition. You can see the coupon code and, dawn, you're welcome to share this with everyone in your network and if you have a question, if you go to the website, hit the contact form. I'm glad to connect with you that way as well. It is pre-approved for certified senior advisor and certified case manager. Renewal CE credits. Cmc what is it? Care manager certified those are pending, hoping any day to have those Again. If you or someone in your office would benefit from the course and they hold any of those designations, they can get some renewal credits for their designation.
Speaker 1:Thank you, bill, so much for that information. It was really helpful. Thanks for being here with us, too, today. I think we might go to the May. You good doing the May leave behinds Lisa, yeah, hey guys.
Speaker 5:Yes, hey, can I say I'd like to say something on behalf of Bill or about before we go on to the. I know we're going to talk about leave behinds and that's awesome. I will say this as a registered nurse, I have played all of these roles, so I have been the person that goes out and certifies that they are available to go on claim, or they should go on claim, that they meet all the criteria. I've done that. I've gone to houses and said yes, filled out all the paperwork. There's certain organizations that hire nurses to go out and do that sometimes. I've also been the long-term care insurance agent, which is today weird because I still get notices of my clients who have not gone on claim yet and they must be 100 years old by now. And then I also have known Bill, like we said in the beginning, for 25 years, and he is probably one of the most trusted folks in long-term care insurance across the United States.
Speaker 5:There is no doubt in my mind that we've been waiting for something like this for a very long time a class that home care agency owners or their business managers in their office or their administrators or somebody can take and then implement and market the fact that they're experts in long-term care insurance claims To be able to say that have the certification behind your name or your organization's name, and that opens up a lot more of this long-term care insurance business and you won't be afraid of not getting paid. You'll know exactly what to say and what to do in all these different little nuanced issues that come up with these things and I'm not saying anybody's afraid to do it, but different little nuanced issues that come up with these things, and I'm not saying anybody's afraid to do it, but you don't. Once you go through the class, you don't risk not being not understanding a policy and you also open yourself up to having lots of resources, because I'm sure, along with the class, you do have lots of folks you could talk to or send an email to and say, hey, we're having trouble with this. What's your recommendation? We don't have guest speakers very often, but we wanted to have Bill on because this is something that I feel like is very important for home care agencies to know and understand to increase their revenue and their bottom line. So I hope that this was helpful to everybody and I hope you consider that his class might be a really good addition to your accounting team, to you, to whoever your salesperson is out there, whoever is opening up cases, and add it to your marketing materials.
Speaker 5:Don't just say we accept long-term care insurance as a one line bullet. We've got a lot of clients who make a very big deal about how they work with long-term care insurance on their website, and you should do that too. It eases the mind of the adult child who's looking for care to know that you understand this stuff, because it can be complicated and they don't know what they're looking at. So anyway, good points, love that.
Speaker 4:Thank you, Valerie, and listen, thank you all for your time and ASN for the opportunity here I will say just continuing that discussion about the class. If you want multiple people from your office to take the class, reach out to me because I could do an additional discount for addition for multiple people in the same office. So, Valerie, thank you so much. I that kind words and I appreciate it. It's taken us way too long to get to today, but I'm glad we're here.
Speaker 1:That's awesome.
Speaker 5:Glad you're here.
Speaker 2:Okay, I'll leave you guys alone, so you can Okay, so we should just skip to May To May.
Speaker 1:They're the new ones and we'll go through March and April again next time.
Speaker 2:Okay, and then maybe, too, we might want to just anyone who is interested in getting the leave behinds, for what are we doing for April.
Speaker 2:If you would please, in the chat, just say yes, and if you're interested in getting these are, it's all of them and we're going to customize them and send them out to you.
Speaker 2:So just yes in the chat and, okay, may leave behind. So the idea behind this and I'm just trying to go really fast this is older Americans month is May and so the I guess the theme this year is flip the script on aging and age how you want to, and aging doesn't have to mean stop doing what you want to do or stop having fun, and so this is designed to, and it has basically 20 ways to help keep seniors young at heart, and it just gives different examples of things that they could be doing. And you want to take this out and just maybe this could become a part of the move-in brochures or any of that type of thing, and this should be able to get someone the social worker, director of nursing care, the executive director to come out and talk to you, because you really want to be able to include this and this will help them to help their seniors help figure out things to do within the community or other. Just I'm trying to get it to you as fast as I can.
Speaker 1:They also can like print. You can give them a lot of them and they can give them out to the adult children that they're working with for ideas for their parents, too. Right, I love this handout.
Speaker 2:Yeah, you helped me with it, thank you so much. And you guys can go in with all of these. You can go in and customize with your logo, your information, at the bottom of course, and there's a link to canva and google, uh, next up, and this is just really. I wanted you guys to be able to see what these words are, because I had to put a whole page into 30, 30 font or whatever, so you can just see 20, 20 ways. Stay connected, join clubs, attend events, call family. Number two is learn something new, a language, a hobby, something different. Three stay active, walk daily, volunteer, laugh often, express creativity and more.
Speaker 2:Lots more. Nurses week Don't forget nurses week 6 to may 12. I just want to say thank you for them being all the difference. And then it gives a little bit of detail on how our caregivers can help care for patients needing one-on-one support, right, and then again you can customize any of these and we have some cool little giveaways to go with these too. Yeah, they're in the giveaways. So I was totally on just looking all over the place. I was so excited about this, but I love these bags. I'm so excited to find these bags and just all this like little scrub looking nurse oh, all of that's on the bag.
Speaker 1:Oh my goodness. I thought that was a graphic you put on there. Oh my goodness very cool.
Speaker 2:The bags come like that, even the tissue paper although there is tissue paper you can find on amazon, because you can find anything that's like little different, like little nursing things, I think a couple of the syringes and some other stuff. They're so cute though, but anyways, just wanted to give you guys a couple of things, because I found so many. But these bags here, notepads, spiral notebooks a little more of an investment here, but I just think they're so cute. They can keep those. They're in school or something nursing school. They can use that for whatever, but I just wanted to share these with you. You guys can go to the store right here at the left-hand side, bottom, and you click and it'll go straight to May and you'll see all of the May giveaways. Again, this is just designed so you don't have to do the legwork.
Speaker 1:And just remember, you can find nurses in skilled nursing facilities. You can find them in assisted living. You can find them in home health. You can find them. There are nurses everywhere, so make sure you're celebrating them this week, may 6th to the 12th.
Speaker 2:Yeah, and here's some more cool stuff Reusable straw covers. How cool are those? Everyone has their stanley cup out and no germs, right? I don't want anything flying into my drink. So here we go. They're really cute and they're very nurse appropriate. I love them. And then there was just I found these really cute little nurse lip balm, and they were specifically designed for nurses week, so I just thought I would love this, lisa.
Speaker 1:Oh, you've done a great job in this. I love it.
Speaker 2:Yeah, I just yeah, thought this would be cool. All right, can't forget celebrating Mother's Day. This one just very. Celebrate Mother's Day and you can take out a couple of different things. Here's some cute giveaways. But call our text Valerie for all your home care needs. But we've got some eye masks, these little steam masks, hand and foot masks, just different little things like that to take out to your social workers and just say you're celebrating Mother's Day. May leave behind Skin Cancer Awareness Month.
Speaker 2:John found these little giveaways actually last year and I just wanted to bring them back because I just think they're so cool. But he doesn't want to be reminding people because, man, some people I knew it was summer starting because they were like bright red lobsters. One day it's starting. Every year they get the same sunburn. But this is really cool just to remind people to take care of the skin. You're in Easy to use skin healthy UV monitoring and if you go to the next screen you'll see these.
Speaker 2:You just stick them on your skin and they have all different kinds. They had dinosaurs, they had you name it but they start out they're white and then they turn purple once the UV rays are getting too hot there. But I just think this is really cute, especially when you're at communities where people are starting to go out and they're doing their luau's and they're out in the sun and they haven't been so much, so these are really great to take out, maybe cut up. So this, your social worker or director of nursing is getting all of the shapes there, but just thought it was a cute idea and wanted to bring it back this year.
Speaker 1:I actually handed these out in my last home care agency, and so when it turns purple, they know to apply sunblock. So these were a huge hit. Everybody loved them and they used them mostly for their kids, I think, but it doesn't matter it was great.
Speaker 2:That's a really cute. Some really cute different ideas too. I think that's it. Yeah, that is that's the last one.
Speaker 1:Thank you everyone for coming. This whole slide presentation will be sent to you, so links that we have on some of them the Canva and the Google docs links all of that is here. You can also probably I think that, bill, you have a link on yours as well Go back to Bill's slide. You can actually go into the slides and there you go. He can take you right to his site and all the information. So you'll get the slide deck and then for the Amazon links, you just go to the stores in the bottom of those slides. Thanks everyone, we'll see you. Thank you guys. Have a great rest of your day, bye-bye, bye-bye. Thank you, bye-bye.
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